Membership Agreement Essentials¶

Overview¶

Your membership agreement is the legal contract between your practice and each patient. It defines the relationship, sets expectations, protects both parties, and ensures clarity about what is included in membership.

A well-crafted agreement prevents misunderstandings, reduces disputes, and supports the unique nature of the DPC model.

[!CAUTION] Have Your Agreement Reviewed by a Healthcare Attorney: This guide provides educational framework only. Your membership agreement is a legal contract that must comply with your state's DPC laws, contract requirements, and healthcare regulations. Never use a template without legal review. An attorney experienced in DPC can ensure your agreement protects your practice and meets state-specific requirements.

Prerequisites¶

Selected your Membership Model
Determined your Pricing
Understanding of services you will offer
Consultation with healthcare attorney (strongly recommended)

Why the Agreement Matters¶

For Your Protection¶

Clarifies that DPC is not insurance
Defines scope of services
Establishes cancellation and refund terms
Documents patient responsibilities
Creates legal record of relationship terms

For Patient Clarity¶

Explains what they receive
Sets realistic expectations
Outlines how to access care
Clarifies costs and payment
Describes what is not included

For Regulatory Compliance¶

Some states have specific DPC legislation requiring certain disclosures
Distinguishes DPC from insurance products
Documents the direct relationship

Essential Sections¶

1. Parties and Definitions¶

Purpose: Identify who is entering the agreement and define key terms.

Include: - Practice legal name and address - Patient name (and responsible party for minors) - Effective date - Definition of "membership," "services," "practice"

Example Language:

This Membership Agreement ("Agreement") is entered into between [Practice Name, LLC] ("Practice") and the individual signing below ("Member" or "Patient") as of the date signed.

2. Nature of the Relationship¶

Purpose: Clearly establish this is a direct care arrangement, not insurance.

Critical Disclosures: - This is NOT health insurance - This does not replace the need for health insurance - This arrangement does not cover hospitalization, specialist care, or emergencies - The practice does not bill insurance for membership services

Example Language:

THIS IS NOT INSURANCE. This Agreement establishes a direct physician-patient relationship for primary care services. This membership does not constitute health insurance and does not replace the need for comprehensive health insurance coverage. Members are strongly encouraged to maintain health insurance for hospitalization, emergency services, specialist care, and other services not provided by this Practice.

State-Specific Note: Some states (e.g., Texas, Louisiana, Oklahoma) have specific DPC statutes that may require additional language. Verify requirements with a local healthcare attorney.

3. Services Included¶

Purpose: Detail exactly what the membership covers.

Categories to Address:

Office Visits - Number of visits (unlimited vs. limit) - Visit duration expectations - Types of visits covered

Communication Access - Phone consultations - Secure messaging - Email policies - Response time expectations

Telehealth - Video visit availability - Platform used - When telehealth is appropriate

Preventive Care - Annual wellness exams - Age-appropriate screenings - Health coaching

Clinical Services - Basic procedures included - Point-of-care testing included - EKG, spirometry, etc.

Care Coordination - Referral coordination - Medical records management - Communication with specialists

Example Language:

Services Included in Membership: - Unlimited office visits during regular office hours - Same-day or next-day appointments when medically appropriate - Annual comprehensive wellness examination - Secure electronic messaging with physician (response within 24 hours on business days) - Telephone consultations - Video telehealth visits - Basic in-office procedures (wound care, ear lavage, joint injections [materials at cost]) - Point-of-care testing (strep, flu, urinalysis) - Electrocardiogram (EKG) - Care coordination and referral management - Prescription management and prior authorizations

4. Services NOT Included¶

Purpose: Prevent misunderstandings about scope of care.

Typically Excluded: - Hospitalization - Emergency room care - Specialist consultations - Surgery - Imaging (X-ray, CT, MRI) - Laboratory services (or note if offered at wholesale) - Immunizations (or note how handled) - Durable medical equipment - Prescription medications - Services requiring facilities not available at practice

Example Language:

Services Not Included: The following are NOT included in membership and Member is responsible for associated costs: - Hospital or emergency room services - Specialist physician services - Surgical procedures - Imaging services (X-ray, CT, MRI, ultrasound) - Laboratory services (available at wholesale cost—see fee schedule) - Immunizations (vaccine cost at wholesale; administration included) - Prescription medications - Durable medical equipment - Mental health services beyond initial assessment - Physical therapy, occupational therapy - Any services provided outside this Practice

5. Fees and Payment Terms¶

Purpose: Document pricing, payment schedule, and financial policies.

Include: - Monthly/annual membership fee - Payment due date - Accepted payment methods - Late payment policy - Returned payment fees - Price for additional services (if any) - How price changes will be communicated

Example Language:

Membership Fees: - Monthly Membership Fee: $_________ per month - Payment is due on the _____ of each month - Accepted payment methods: Credit card, debit card, ACH bank transfer - A fee of $25 will be charged for returned payments - Membership fees may be adjusted annually with 60 days written notice

Additional Service Fees: Laboratory services, vaccines, and certain procedures may incur additional charges. A current fee schedule is available upon request.

6. Term and Renewal¶

Purpose: Define membership duration and renewal process.

Options: - Month-to-month (most flexible) - Annual with monthly payments - Annual prepaid

Example Language (Month-to-Month):

This Agreement begins on the Effective Date and continues on a month-to-month basis until terminated by either party. Membership will automatically renew each month unless terminated in accordance with this Agreement.

Example Language (Annual):

This Agreement is for an initial term of twelve (12) months beginning on the Effective Date. Membership will automatically renew for successive twelve-month terms unless either party provides written notice of non-renewal at least thirty (30) days prior to the end of the current term.

7. Cancellation and Termination¶

Purpose: Define how either party can end the relationship.

Patient Cancellation: - Notice period required (typically 30 days) - How to submit cancellation - Refund policy (if any) - Final payment obligations

Practice Termination: - Reasons practice may terminate (non-payment, abusive behavior, non-compliance, practice closure) - Notice period (typically 30 days except for cause) - Continuity of care obligations

Example Language:

Cancellation by Member: Member may cancel this Agreement at any time by providing written notice to the Practice. Cancellation is effective thirty (30) days after receipt of notice. Membership fees are non-refundable; however, Member will have access to services through the end of the paid period.

Termination by Practice: Practice may terminate this Agreement: - With thirty (30) days written notice for any reason - Immediately for cause, including but not limited to: non-payment, abusive or threatening behavior toward staff, repeated failure to follow medical recommendations in a manner that endangers health, or fraudulent activity

Upon termination, Practice will provide Member with copies of medical records and reasonable assistance in transitioning to another physician.

8. Refund Policy¶

Purpose: Clearly state refund terms to prevent disputes.

Common Approaches: - No refunds (most common for monthly memberships) - Prorated refunds for annual prepaid memberships - No refunds for cause termination

Example Language:

Refund Policy: Monthly membership fees are non-refundable. For annual prepaid memberships, if Member cancels after the initial thirty (30) days, a prorated refund will be issued for complete months remaining in the term, less a $50 administrative fee. No refunds will be issued for termination for cause by the Practice.

9. Patient Responsibilities¶

Purpose: Outline what you expect from members.

Common Responsibilities: - Provide accurate health information - Keep appointments or cancel with notice - Follow treatment recommendations (to extent willing) - Treat staff with respect - Maintain updated contact and payment information - Maintain health insurance for non-covered services

Example Language:

Member Responsibilities: Member agrees to: - Provide accurate and complete health information - Notify Practice of any changes in health status, medications, or contact information - Cancel or reschedule appointments with at least 24 hours notice when possible - Treat Practice staff with courtesy and respect - Maintain a valid payment method on file - Maintain health insurance coverage for services not covered by this membership - Seek emergency care at an emergency room or call 911 for medical emergencies

10. Privacy and Medical Records¶

Purpose: Address HIPAA and records policies.

Include: - Reference to Notice of Privacy Practices - Medical records ownership and access - Records retention policy - Records release process

Example Language:

Privacy and Medical Records: Practice maintains Member's medical records in compliance with all applicable laws, including HIPAA. Member has received or been offered the Practice's Notice of Privacy Practices. Member may request copies of medical records at any time; a reasonable fee may be charged for copying and processing. Medical records will be retained in accordance with state law requirements.

11. Communication and Response Times¶

Purpose: Set realistic expectations for access.

Include: - Office hours - After-hours policy - Expected response times - Emergency protocols

Example Language:

Communication: Office hours: Monday through Friday, 8:00 AM to 5:00 PM Secure messages will receive a response within one business day. Phone calls during office hours will be returned the same day when possible. After-hours non-emergency messages will be addressed the next business day.

Emergencies: For medical emergencies, call 911 or go to the nearest emergency room. This Practice does not provide emergency services. After-hours urgent concerns may be addressed via [phone/text/portal]—check current after-hours policy.

12. Limitation of Liability¶

Purpose: Limit practice liability where legally permissible.

Note: This section requires careful legal review. Limitations must be reasonable and compliant with state law.

Example Language:

Limitation of Liability: Practice will provide services in accordance with accepted medical standards. Practice's liability under this Agreement is limited to the fees paid by Member during the twelve (12) months preceding any claim. This limitation does not apply to claims arising from gross negligence or willful misconduct.

13. Dispute Resolution¶

Purpose: Define how disputes will be handled.

Options: - Mediation first - Binding arbitration - Litigation with venue specified

Example Language:

Dispute Resolution: Any dispute arising from this Agreement shall first be addressed through good-faith negotiation between the parties. If unresolved, disputes shall be submitted to mediation before a mutually agreed mediator. If mediation fails, disputes shall be resolved through binding arbitration in [County, State] in accordance with the rules of the American Arbitration Association.

14. Signatures¶

Purpose: Document agreement by both parties.

Include: - Patient/guardian signature line - Date line - Practice representative signature (optional but recommended) - Witness line (if required by state)

State-Specific Considerations¶

States with DPC-Specific Legislation¶

As of 2024, most states have enacted DPC legislation clarifying that DPC is not insurance. Requirements vary. Key states with specific requirements:

State	Key Requirements
Texas	Specific disclosures required; template language available
Washington	First DPC law; specific definitions
Louisiana	Requires specific contract provisions
Idaho	Specific disclosure requirements

Action: Research your state's DPC statute or consult a local healthcare attorney.

Medicare Considerations¶

If you will accept Medicare patients: - Cannot charge for services covered by Medicare - Consider opt-out or non-participating status - Specific contract language may be required - Complex area—consult healthcare attorney

Template Development Process¶

Step 1: Start with a Foundation¶

Use this guide as a framework
Review sample DPC agreements (available through DPC Alliance and other organizations)
Never copy another practice's agreement without legal review

Step 2: Customize for Your Practice¶

Insert your specific services
Add your pricing and payment terms
Reflect your office hours and policies
Include your state's required language

Step 3: Legal Review¶

Have a healthcare attorney review your draft
Ensure state-specific compliance
Verify insurance/non-insurance language is appropriate
Confirm limitation of liability is enforceable

Step 4: Test Readability¶

Have non-medical friends read it
Ensure average person can understand terms
Simplify language where possible without losing legal protection

Step 5: Create Patient-Friendly Summary¶

Consider a one-page summary of key points
Not a replacement for full agreement
Helps patients understand quickly

Checklist: Membership Agreement¶

Content¶

Legal Review¶

Healthcare attorney reviewed
State-specific requirements met
Medicare language appropriate (if applicable)
Insurance/non-insurance disclaimers compliant

Implementation¶

Final version approved
Copies available for patients
Electronic signature option (if desired)
Storage system for signed agreements
Process for providing copy to patient

Resources¶

Template Membership Agreement (planned)
Direct Primary Care Alliance - Member resources
Your state medical board for state-specific requirements
Healthcare attorney for legal review

Next Steps¶

After creating your agreement: - Payment Processing Options - Collecting membership fees - Patient Onboarding Workflow - Using the agreement in enrollment - HIPAA Compliance Basics - Privacy practices referenced in agreement